Procedure coding
Typically, procedure coding for mechanical thrombectomy of intracranial vessels is well-established in European countries. For example, in France, there is a specific CCAM code EAJF34 “Evacuation of thrombus of an intracranial artery by transcutaneous arterial route”.
In some countries, the coding might be complex, with multiple codes depending on the number of treated vessels or type of devices used. For example, in Germany, there are several additional OPS codes for microwire retrievers or stent retriever systems for thrombectomy (code group 8-83b.8-), which differ depending on the number of systems used.
Payment mechanism
In most EU countries, mechanical thrombectomy is reimbursed solely via the diagnosis-related group (DRG) mechanism.
In some countries (e.g., England, France, Germany), the devices for mechanical thrombectomy attract additional reimbursement, paid on top of the DRG tariff (e.g., LPPR List in France and High Cost Device List in England). For example, in England, there is a specific category in the High Cost Devices List, “Mechanical Thrombectomy Stent Retrievers and Clot Retrievers”. It includes consumables that are required uniquely for the deployment of the device.
Add-on reimbursement can be either generic (at the class level, as in Germany) or brand-specific (with specific LPPR codes for individual brands in France).
Policy considerations
Due to high medical and social importance, mechanical thrombectomy in stroke can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
For example, in England, the national payer, NHS England, developed the Clinical Commissioning Policy “Mechanical thrombectomy for acute ischemic stroke (all ages)”, in which NHS England decided to routinely commission mechanical thrombectomy at the national level for all of the patients, of all ages with proximal occlusion of the internal carotid or middle cerebral arteries who present early after the stroke before there is irreversible ischaemic damage to the brain.
In some countries, national decision-makers can restrict reimbursement of mechanical thrombectomy. For example, in the Netherlands, mechanical thrombectomy is reimbursed under specific conditions, defined by the Dutch Healthcare Institute in the Position “Intra-arterial treatment of acute cerebral infarction” (2016).
Health technology assessment
Due to established reimbursement in European countries, mechanical thrombectomy in stroke has not become a subject of HTA in the recent years.
Future challenges
Mechanical thrombectomy in stroke has established reimbursement and funding in many European countries. New health technology assessments are unlikely.
Novel devices for mechanical thrombectomy with unique designs or properties or different cost profiles might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, and policy considerations)
Development of reimbursement strategy
Development of the value dossier
Performing evidence gap analysis for novel technologies
Development of reimbursement and HTA submission dossiers
Adaptation of the global health economic model to EU settings
MTRC has experience with more than 9 projects related to mechanical thrombectomy in Europe
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